DS-06-1519 Miami Shores Village - ��
Building Department JUL 06 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B ;.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 s
BUILDING Master Permit No. 06- Ciel
PERMIT APPLICATION Sub Permit No.
(BUILDING (0ECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [j RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
r 4 CONTRACTOR DRAWINGS
JOB ADDRESS: /®®® ®
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 14-3� e-23 —0/3Z) Is the Building Historically Designated:Yes NO
Occupancy Type4 Load: Construction Type: Flood Zone: BFE:: L eF�FE:
OWNER:Name(Fee Simple Titleholder): ��
� + � �yvPhone#:
Address: �2—':M®
City: / State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: ,�r
Type of Work: ❑ Addition ❑ Alteration ❑ Newq ❑ Repair/Replace E-1Demolition
Description of Work: �_ 2 / �`ff-J f/
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
t
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature L-�j&\Ad Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
od0 day of J(k-tiL 20 (C ,by day of .20 by
who is g ersonally known o who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: �� Sign:
Print: Print:
.anurq,
Seal: NUN MEJ1ASeal:
:°• `� Iu�-State of Roft
My .Comm.Expires Mar 27.2018
Co FF 74357
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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July 61h, 2016
Miami Shores Village
Planning and Zoning department
10050 N.E 2nd Ave,
Miami Shores, Florida 33138
To whom it may concern,
I,Axel Jordan, Manager of the company Carbonell#3307 LLC owners of the property located at 10151
NE 14Ave would like to request the following permit cancellations:
1-Driveways/Sidewalks/Slabs DS-6-06-1519 (Slab for new generator)
2-Electrical-Residential EL-6-06-1520(Electrical for new generator)
3-Plumbing-Residential PL-6-06-1522 (Gas unit for new generator)
I am requesting the cancellation since the job was not done nor will be.
If you shall have any questions or require additional information feel free to contact me at any time to
the telephone number and/or email address listed below.
Kind Regards,
Alex Jordan
T: +1(78 22 4264
40
A kc-L 30- #Z�p �3
STATE OF FLORIDA COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this /6 day of 20 /-C ,
By X L-E_X —40 tza)A')
Signature of Notary Public
Print Name cJC.f eo No
i,,., o�a� Qob�B`o�#F,aA21`�Pgs.
Personall ,ower tification